Boston SSI Appeals Involving Residual Functioning Capacity

When a claimant applies for Social Security Disability Insurance (SSDI) benefits in Massachusetts, the U.S. Social Security Administration (SSA) will only approve an application if they are convinced claimant is eligible for SSDI benefits by having paid into the system through enough years of working and has subsequently become disabled. Disabled means unable to engage in substantial gainful activity, which is defined as one’s ability to earn more than approximately $1,120 in any given month. SSA will look at all medical evidence and opinion statements, or testimony should there be a hearing before an administrative law judge (ALJ), to determine a claimant’s residual functioning capacity.

A claimant’s residual functioning capacity or “RFC” as it is often called by ALJs and Boston disability attorneys, is one’s ability to work despite having one or more serious medical conditions. The way this is supposed to work is SSA reviewers look at all evidence and then look to the Dictionary of Occupational Titles (DOT). The Dictionary of Occupational Titles contains a long list of many different jobs in the local (Boston area) or national economy, and includes a list of the requirements needed to obtain and keep one of these jobs. If the claimant cannot lift, bend, crouch, squat, stand or sit, for example, a job may not be appropriate for this claimant. If SSA determines claimant can work one of these jobs, even if it pays much less than claimant’s previous type of employment, SSA will likely deny any disability benefits via a finding of no disability. As our Boston SSDI attorneys know, most applications are initially denied, and the subsequent requests for reconsideration are almost always denied as well. This means most claimants will have to go a hearing before an ALJ, where evidence will be presented and testimony will be taken. ALJ will then determine a claimant’s RFC, if any, from that evidence, which often includes hearing from a Vocational Expert (VE). A VE works for SSA and specializes in applying the descriptions in the Dictionary or Occupational Titles to hypothetical claimants who are substantially similar to the claimant.

Thomas v. Berryhill

Thomas v. Berryhill, an SSI appeal from the U.S. Court of Appeals for the Eighth Circuit, involved a claimant who was a 34-year-old woman who had a four-year-old daughter and was in the process of getting divorced. She was able to live by herself and generally take care of herself. She had half-time custody of her child and was able to care for her as well when she was at her home. She was able to drive and had a valid license, but she was very anxious behind the wheel. She was given an IQ test and scored a 70. She was also suffering from morbid obesity, painful arthritis, and depression.

She had never held a job and had been on Supplemental Security Income (SSI) benefits since she turned 18. However, SSI is an income-based program where, unlike Social Security Disability Insurance benefits, household income is taken into account. This meant when she married her husband, his income was used when making the calculations and it made her ineligible to continue receiving SSI benefits. Thus, her benefits were terminated.

Once she filed for divorce, she applied for SSI benefits again, claiming she still could not work and now no longer had access to her husband’s income — so she believed she would qualify for benefits again. Unfortunately, her application was denied and when she applied for reconsideration, she was rejected once again. Once she had a hearing before an ALJ, it was determined she had a residual functioning capacity, allowing her to engage in substantial gainful employment. So her denial was affirmed. She then filed a case with the federal district court in which jurisdiction was proper. At this point in the process, a federal magistrate affirmed ALJ’s decision to deny benefits and she appealed to the U.S. Court of Appeals for the Eighth Circuit.

In her appeal, she claimed ALJ had erred as a matter of law because the government had failed to give proper weight to her treating physician as to her residual functioning capacity, and relied too heavily on other evidence. There is a presumption in favor of a treating physician unless his or her opinion is overruled or discredited through a record showing substantial evidence to the contrary. In this case, the court of appeals agreed with SSA and found ALJ properly relied on other evidence to discredit her treating physician’s opinion. However, the job for which she was found capable of performing was that of a new accounts clerk from the Dictionary of Occupational Titles.

While this would have been okay, the problem was it did not appear to the court of appeals she could actually perform the functions of this particular occupation. Appeal court reversed the matter to have a five-step analysis performed by ALJ to see if there was a job in the Dictionary of Occupational Titles she could actually obtain and hold. If there was not such a job, she should be declared disabled.

There is a ruling by SSA an ALJ cannot find a claimant not disabled based upon a job description if there is an obvious conflict between job requirements and testimony of a Vocational Expert. In this case, Vocational Expert testified a person could be a new accounts clerk if he or she is able to perform what is known as a two-step task. However, in the Dictionary of Occupational Titles, it clearly states a new accounts clerk requires someone who is able to complete a three-step task and the medical evidence in this case only found her able to do a two-step task. SSA argued the Dictionary of Occupational Titles is only a generic list that gives the most complex tasks a claimant would have to do in a particular job, but the real job could have lesser requirements. The court did not agree with this interpretation.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.